My awful Friday 13th--LOOOONG POST

[iamarn]

Hello. I guess I am just coming here to vent. I started HH back in 09/06 and have really enjoyed it. This past Friday was probably the worst day I have had so far in HH. Of course, it had to be Friday 13th. I started the day with 9 1/2 pts (counting admissions and oasis d/c'd). I told my clinical manager that there was no way that I could do all of these due to driving distance and time taken with pt. (3 of the pts. were wound vacs). After getting that taken care of, I was on my way to see pts.

My fist pt. was an admission and he had a wound vac. Man had an extensive history and really liked to talk. Took my almost 2 hours to do admission and wound vac dressing change.

Go to next pt. who is a female who had a brown recluse (sp?) spider bite 2 years ago and infection keeps having flare ups with infection from the bite. About 2 weeks ago, she was referred to another surgeon who is approx. 1 hour from our town. The surgeon debrided the poor girls hip where she was bit. Her wound measurements are 23x12x7cm. The doctor only gave her Lortab to take for pain which I always call before going and tell her what time i will be there so she can take her pain pill in time for it to work before I get to her home. She was also sent home from hospital with PICC line and is On IV Vancomycin and Maxipime. When I get to her home, she tells me that she did not take her a.m. dose of Vancomycin b/c it made her chest hurt, SOB, and hurt in arms and legs. I call infectious disease doctor and get all of that taken care of. Then I start on pt. dressing change. She is on wound vac. we always line the whole wound with adaptic to ease the removal of the black foam. Even with the adaptic, it is excrutiatingly painful for pt. She is crying and yelling the whole time I am trying to remove dressing. After 1 1/2 hours, I finally get dressing out. Redress everything with foam, drape, and T.R.A.C set and turn vac on. The sucking down is also painful for pt. So, I proceed to call surgeon's office to see about maybe getting some pain medicine to push through PICC line before dressing changes and maybe decreasing dressing changes to 2xweek d/t pt. not being able to tolerate. Of course, I had to leave message for the doctor/nurse to call me back. That visit took me over 2 hours.

So, I head to next pt. home which is 40 minutes away. Get there, he is also on wound vac to heel. He had an apligraft placed Monday, 04/09/07. MD orders were to remove vac dressing down to steristrips (which were put to hold apligraft in place). When I got to home th pt. states, I noticed early this morning there was bleeding coming out from around the dressing under the drape. I proceeded to take dressing off very carefully, guess what? when I removed dressing, steri strips were stuck to drape and the whole apligraft come off with the dressing! There was supposed to be vaseline gauze over steri-strips to prevent this. I don't now if when the nurse at the wound center put vac on on Monday if she didn't cover the steristrips with vaseling gauze or when pt. started bleeding it loosened the steristrips from skin. I called wound center where pt. had apligraft placed and spoke with nurse. Nurse was kind of snappy and stated "Dr. ________ is not going to be happy". I proceeded to tell her that there was no way that this could have been prevented. She wanted my first and last name and phone number so he could call when pt. come back in on Monday, 04/16/07. Called and spoke with another nurse in office who has done home health for years. She states that she has never seen a doctor put a wound vac over apligraft. Have any of you? While I was in this pt. house the nurse from the surgeon's office called me back on my cell, but I didn't get the call because my cell wouldn't get signal at home. By the time i got ta place where I actually knew that I had a voice mail, I tried to call nurse back and office closed!!

I then proceeded to my last pt. home which was an Oasis d/c which went fairly well. Then I came home to do mounds of paperwork. What a day!!

Sure hope next week is better. Sorry, for the long post. Really would like to know if anyone has seen wound vac placed over apligraft.

[Cattitude]

Ugh, we all have days I think like that. I hate when it happens on Fridays and Mondays..

I've not seen wound vacs on Apligrafts. I would think the site too delicate to have the vac?